Brain dose-sparing radiotherapy techniques for localized intracranial germinoma: Case report and literature review of modern irradiation

Leung, Henry W.C.; Chan, Agnes L. F.; Chang, Mu-Bai

doi:10.1016/j.canrad.2016.02.007

Cited by 5 publications

(6 citation statements)

References 53 publications

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“…Especially in this population, a decrease in IQ, processing speed, and fine motor skills have been reported after chemoradiation, with memory impairment associated with a D max > 30 Gy to the temporal lobe [29] . When normal tissue volumes such as the supratentorial brain or temporal lobes receive less of the low and intermediate doses [28] , it resulted in clinically significant higher IQ scores for patients with intracranial tumors [30] .…”

Section: Resultsmentioning

confidence: 99%

“…PT is an acknowledgeable technique for normal tissue sparing in pediatric cranial RT, with its predicted consistently lower doses to critical normal tissues and ID to the body [38] compared with photons [30] . Regarding WV-RT, MacDonald published one demonstrative case of WV-RT/TB in localized IGCT (WV = 23.4 Gy, boost 45 Gy) where intensity-modulated proton therapy with fine pencil beams (σ = 3 mm) allowed additional sparing over IMRT and conformal PT (passive scattering or PBS) [8] .…”

Section: Resultsmentioning

confidence: 99%

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Whole-ventricular irradiation for intracranial germ cell tumors: Dosimetric comparison of pencil beam scanned protons, intensity-modulated radiotherapy and volumetric-modulated arc therapy

Correia

Terribilini

Zepter

et al. 2019

Clinical and Translational Radiation Oncology

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Background: Whole-ventricular radiotherapy (WV-RT) followed by a boost to the tumor bed (WV-RT/TB) is recommended for intracranial germ cell tumors (IGCT). As the critical brain areas are mainly in the target volume vicinity, it is unclear if protons indeed substantially spare neurofunctional organs at risk (NOAR). Therefore, a dosimetric comparison study of WV-RT/TB was conducted to assess whether proton or photon radiotherapy achieves better NOAR sparing. Methods: Eleven children with GCT received 24 Gy(RBE) WV-RT and a boost up to 40 Gy(RBE) in 25 fractions of 1.6 Gy(RBE) with pencil beam scanning proton therapy (PBS-PT). Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans were generated for these patients. NOAR were delineated and treatment plans were compared for target volume coverage (TVC), homogeneity index (HI), inhomogeneity coefficient (IC) and (N)OAR sparing. Results: TVC was comparable for all three modalities. Compared to IMRT and VMAT, PBS-PT showed statistically significant optimized IC, as well as dose reduction, among others, in mean and integral dose to the: normal brain (-35.2%,-32.7%; À35.2%,-33.0%, respectively), cerebellum (-53.7%,-33.1%;-53.6%,-32.7%) and right temporal lobe (-14.5%, À31.9%; À14.7%, À29.9%). The Willis' circle was better protected with PBS-PT than IMRT (À7.1%; À7.8%). The left hippocampus sparing was higher with IMRT. Compared to VMAT, the dose to the hippocampi, amygdalae and temporal lobes was significantly decreased in the IMRT plans. Conclusions: Dosimetric comparison of WV-RT/TB in IGCT suggests PBS-PT's advantage over photons in conformality and NOAR sparing, whereas IMRT's superiority over VMAT, thus potentially minimizing long-term sequelae.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Whole-ventricular irradiation for intracranial germ cell tumors: Dosimetric comparison of pencil beam scanned protons, intensity-modulated radiotherapy and volumetric-modulated arc therapy

Correia

Terribilini

Zepter

et al. 2019

Clinical and Translational Radiation Oncology

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“…Reducing the field to whole‐brain radiotherapy (WBR) can be associated with a subacute and delayed decline in memory and other cognitive functions. 22 …”

Section: Discussionmentioning

confidence: 99%

“…Because of the good prognosis of treatment, and multiple treatment protocols available, it is therefore no surprise that there are several different recommended treatment protocols (Table 3 ), with some studies supporting a wide‐field NC approach, 19 , 20 , 22 , 23 , 28 , 30 , 31 , 32 with others support the use of NC + RT. 1 , 24 , 26 , 29 However, narrow‐field RT or NC alone have high relapse risks and are not recommended to cure GN.…”

Section: Discussionmentioning

confidence: 99%

“…Reducing the field to whole-brain radiotherapy (WBR) can be associated with a subacute and delayed decline in memory and other cognitive functions. 22 A further reduction to WVR by IMRT and three-dimensional conformal radiation therapy (3DCRT) was also evaluated. 32 Although IMRT is associated with an increased dose of radiation to peripheral areas of the body, it better preserves the normal tissue of the CNS, when compared to either 3DCRT or WBR.…”

Section: Discussionmentioning

confidence: 99%

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Pineal germinoma in a young adult: A case report

Fernández-Rodríguez

Maldonado

2022

Cancer Reports

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Background Intracranial germinomas (GN) are rare cancers that primarily affect children, making them rarer still in adults. Standard treatment for this neoplasm includes neoadjuvant chemotherapy (NC) followed by radiotherapy (RT) or RT at a higher dose and larger field. These recommendations are based on studies focused mostly on children; it is currently unclear whether this treatment is applicable to adults. Case We present a case of a 23‐year‐old adult male with no underlying pathologies, drug allergies, or family history of cancer, who presented for medical evaluation with blurred vision, diplopia, forgetfulness, and weight loss starting 3–4 months before the evaluation. Clinical examination indicated Parinaud's Syndrome. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a pineal tumor with ependymal dissemination in both lateral ventricles, which was causing obstructive hydrocephalus. The patient had surgery consisting of ventriculostomy, Holter shunt insertion, cisternal ventricular intubation, and cisterna magna anastomosis to improve ventricular drainage. Pathology confirmed pineal germinoma. Cerebrospinal fluid cytology and MRI of the axis were negative. Four cycles of NC were given to the patient (carboplatin, etoposide, and ifosfamide), with reduced dosage. Once a partial volumetric response was confirmed, whole‐ventricular radiotherapy (WVR) was initiated with a total tumor bed dose of 45 Gy over 25 sessions in 5 weeks. Optimum clinical results were observed, and no short‐term (<90 day) radiation toxicity was observed. The patient was able to resume his normal activities soon after treatment. Follow‐ups over 2 years post‐surgery indicated continued control of the lesion and absence of symptoms except for mild diplopia. Conclusion Although this is a case report, these data suggest that a reduced NC course and WVR may effectively treat adult GN. This protocol likely decreases the risk of undesirable NC and RT secondary effects, while providing excellent local control; however, using a narrower RT field is not recommended.

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Experimental and Preclinical Tools to Explore the Main Neurological Impacts of Brain Irradiation: Current Insights and Perspectives

et al. 2020

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Brain dose-sparing radiotherapy techniques for localized intracranial germinoma: Case report and literature review of modern irradiation

Cited by 5 publications

References 53 publications

Whole-ventricular irradiation for intracranial germ cell tumors: Dosimetric comparison of pencil beam scanned protons, intensity-modulated radiotherapy and volumetric-modulated arc therapy

Whole-ventricular irradiation for intracranial germ cell tumors: Dosimetric comparison of pencil beam scanned protons, intensity-modulated radiotherapy and volumetric-modulated arc therapy

Pineal germinoma in a young adult: A case report

Experimental and Preclinical Tools to Explore the Main Neurological Impacts of Brain Irradiation: Current Insights and Perspectives

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